Sunday, May 27, 2012

Exclusive Contracts and Sanctum Sanctorum

How does a country founded on the freedom of choice succumb to Exclusive Contracts. The Exclusive contract is a covenant between a hospital and a group of physicians that allows the group to provide exclusive service in a particular field thereby preventing other physicians from practicing in that hospital. The excluded physicians are not allowed to practice their own specialty in the given hospital. The qualifications, skill levels or reputation of the physicians are not taken into consideration. This is solely based on economic credentialing. In some cases exclusive contracts are negotiated by influential but ageing surgeons with declining surgical skills in order to eliminate their competition. While the lawyers dwell only on the legality, the Exclusive Contracts defile the sacred ground of patient –doctor relation.

In a field like heart surgery the patients have no way to judge the competence of the surgeon except through the referring physicians. In most practices the referring physicians have multiple choices of the surgeons. The referring doctors will scrupulously refer the patient to those surgeons whom they will trust to operate upon themselves or their loved ones. For the poor trusting patients, this is the only safety mechanism in place. This is true for the entire practice of medicine, but more so for a surgical field like heart surgery. As physicians we create our own little sacred space with our patients. Only other physicians whom we allow in this sacred space are those whom we trust. Exclusive contracts, by eliminating the choice, breach the sanctum sanctorum between the patient and the doctor.